Psychological flexibility and self-concealment as predictors of disordered eating symptoms.

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1 Georgia State University Georgia State University Psychology Faculty Publications Department of Psychology 2012 Psychological flexibility and self-concealment as predictors of disordered eating symptoms. Akihiko Masuda Georgia State University, amasuda@gsu.edu Robert D. Latzman Georgia State University, rlatzman@gsu.edu Follow this and additional works at: Part of the Psychology Commons Recommended Citation Masuda, Akihiko and Latzman, Robert D., "Psychological flexibility and self-concealment as predictors of disordered eating symptoms." (2012). Psychology Faculty Publications. Paper This Article is brought to you for free and open access by the Department of Psychology at Georgia State University. It has been accepted for inclusion in Psychology Faculty Publications by an authorized administrator of Georgia State University. For more information, please contact scholarworks@gsu.edu.

2 Running head: SELF-CONCEALMENT AND DISORDERED EATING 1 Psychological Flexibility and Self-Concealment as Predictors of Disordered Eating Symptoms Akihiko Masuda and Robert D. Latzman Georgia State University Author Note Akihiko Masuda and Robert Latzman Department of Psychology, Georgia State University Correspondence regarding this article should be addressed to Aki Masuda, Department of Psychology, Georgia State University, Atlanta, GA 30303, USA. Address: amasuda@gsu.edu

3 Running head: SELF-CONCEALMENT AND DISORDERED EATING 2 Abstract The present cross-sectional study investigated whether self-concealment and psychological flexibility were uniquely associated with different facets of disordered eating (DE; i.e., dieting, bulimia/food preoccupation, and oral control) and whether these associations varied across gender. Participants included 621 female and 212 male college students, ages years old. After controlling for age, ethnicity, and BMI, both selfconcealment and psychological flexibility were uniquely related to dieting. Controlling for these demographic variables, psychological flexibility, but not self-concealment, was uniquely associated with bulimia/food preoccupation. Neither self-concealment nor psychological flexibility was uniquely associated with oral control. Finally, gender moderated the association between self-concealment and dieting, suggesting that selfconcealment was relevant to dieting in the female group, but not in the male group. Limitations of the study and future directions are discussed. Key Words: Psychological Flexibility, Disordered Eating, Self-Concealment.

4 Running head: SELF-CONCEALMENT AND DISORDERED EATING 3 Psychological Flexibility and Self-Concealment as Predictors of Disordered Eating Symptoms Disordered eating (DE) is multifaceted (Fairburn, Cooper, & Shafran, 2003; Garner, Olmsted, Bohr, & Garfinkel, 1982) and pervasive among adolescents and young adults in the United States (Striegel-Moore & Bulik, 2007; Vohs, Heatherton, & Herrin, 2001). Although only a small number of these individuals meet diagnostic criteria for an eating disorder (Hudson, Hiripi, Pope, & Kessler, 2007), many endorse some facets of DE, such as dieting, negative body image, and compensatory behaviors (e.g., excessive exercise, purging, laxative use; Mintz & Betz, 1988). Research also shows that DE is pervasive across gender (Lavender & Anderson, 2010; Striegel-Moore & Bulik, 2007) and ethnic background (Mintz & Kashubeck, 1999; Rogers Wood & Petrie, 2010). Many factors are theorized to contribute to the onset and maintenance of DE (Fairburn et al., 2003; Striegel-Moore & Bulik, 2007). One such factor that has been of great interest in recent years is emotion/behavior regulation (Aldao & Nolen-Hoeksema, 2010; Gross, 2002; Hayes, Luoma, Bond, Masuda, & Lillis, 2006). The construct of emotion/behavior regulation parallels a recent focus in cognitive behavioral therapy (CBT) models of psychopathology. These models suggest that diverse forms of psychopathology, including DE, are attributable not only to the presence of negative internal experiences (e.g., emotion, cognition, and bodily sensation), but also to how one responds to or relates to them. Emotion/behavior regulation abilities can be roughly defined as the processes by which individuals influence the psychological experiences they have, and how emotions are experienced and expressed accordingly (Gross, 1998; Rawal, Park, & Williams, 2010). Maladaptive regulation processes, such as, rumination, experiential avoidance, and thought

5 Running head: SELF-CONCEALMENT AND DISORDERED EATING 4 suppression, are found to be associated with a broad range of distress, including DE (Aldao & Nolen-Hoeksema, 2010; Aldao, Nolen-Hoeksema, & Schweizer, 2010; Rawal et al., 2010). Self-Concealment Self-concealment reflects an underlying maladaptive regulation process in diverse clinical phenomena, including DE. Self-concealment is construed as a general and stable behavioral tendency to keep distressing and potentially embarrassing personal information from others. This behavioral pattern involves the processes of (a) possessing a negatively evaluated secret, (b) keeping it from others, and (c) avoiding or feeling apprehensive about self-disclosure (Larson & Chastain, 1990). Extant literature has reported that individuals who endorse DE tend to distort or withhold personal information, such as their problematic eating, drive for thinness, and negative body image (Pryor, Johnson, Wiederman, & Boswell, 1995; Vandereycken & Van Humbeeck, 2008). Research has also shown that selfconcealment is in fact positively associated with general DE symptoms (i.e., diet, bulimia/food preoccupation, and oral control combined) and DE cognitions (Masuda, Boone, & Timko, 2011). Diminished Psychological Flexibility Another behavioral process that has been widely studied in recent years is psychological flexibility (Hayes et al., 2006; Hayes, Villatte, Levin, & Hildebrandt, 2011). The construct of psychological flexibility is derived from an acceptance- and mindfulnessbased CBT, Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2012). ACT emphasizes open and flexible ways of experiencing internal and external environments to promote greater vital living. Psychological flexibility is conceptualized as

6 Running head: SELF-CONCEALMENT AND DISORDERED EATING 5 a process of (a) experiencing the present moment as it is without judgment and avoidance and (b) persisting or changing behavior when doing so serves valued-ends (Hayes et al., 2006). According to an ACT theory, greater psychological flexibility is theorized to be a cornerstone of behavioral health (Kashdan & Rottenberg, 2010). Conversely, many forms of psychopathology are marked by diminished psychological flexibility, which reflects the domination of maladaptive affect/behavior regulations (e.g., thought suppression and avoidance) and the deficits of contingency-sensitive and value-directed behaviors. Indeed, a growing body of evidence has demonstrated diminished psychological flexiblity is associated with a wide range of behavioral problems (Hayes et al., 2006), including general DE problems (Masuda, Price, & Latzman, 2012; Rawal et al., 2010). Self-Concealment and Psychological Flexibility as Predictors of Disordered Eating Preliminary findings with non-clinical college samples suggest that selfconcealment and psychological flexibility are related but distinct processes uniquely and separately associated with a range of psychological distress (Masuda, Anderson, & Sheehan, 2009; Masuda, Anderson, et al., 2011), including DE (Masuda, Boone, et al., 2011). In regards to the associations among self-concealment, psychological flexibility, and DE symptoms, several questions still remained unanswered. First, as DE is multifaceted (Garner et al., 1982), it is important to investigate whether self-concealment and psychological flexibility are associated with specific aspects of DE, but not with other facets of DE. As a given form of DE symptoms may be qualitatively different from other DE symptoms (Williamson, Gleaves, & Stewart, 2005), it is possible that the association among self-concealment, psychological flexibility, and DE may vary, depending on the type of DE symptoms (e.g., diet, bulimia/food preoccupation, and oral control). Second,

7 Running head: SELF-CONCEALMENT AND DISORDERED EATING 6 previous studies have not examined whether the associations among self-concealment, psychological flexibility, and DE symptoms vary across gender. As gender is found to be a major predictor of DE (Striegel-Moore & Bulik, 2007) and gender differences are found in associations between regulation process and internalizing problems (Cramer, Gallant, & Langlois, 2005), it seems worthwhile to investigate whether gender moderates these associations. Given the pervasive nature of DE in adolescents and young adults, investigating these associations has practical value for case conceptualization and assessment, and perhaps for the treatment of DE. Present Study Given these emerging questions, the present study first investigated whether selfconcealment and psychological flexibility were uniquely associated with specific sets of DE symptoms (i.e., diet, bulimia/food preoccupation, and oral control). Subsequently, the study investigated whether these associations varied by gender. Given previous findings (e.g., Masuda, Boone, et al., 2011), it was predicted that, after controlling for gender, ethnicity, and BMI, both self-concealment and psychological flexibility would be related to all aspects of DE. Given the dearth of evidence, we did not make any a priori hypotheses regarding whether gender would moderate the associations between self-concealment and DE symptoms or the links between psychological flexibility and DE symptoms. Method Participants The current cross-sectional study was conducted at a large, urban, public 4-year university in the Southeastern United States. Participants were recruited from undergraduate psychology courses through a web-based research survey tool. Nine hundred

8 Running head: SELF-CONCEALMENT AND DISORDERED EATING 7 and eighty-seven participants (75%, n Female = 738) completed a survey package that contained multiple self-report measures. Of those individuals, 39 participants (92%, nfemale = 36) were excluded from the study because their self-reported information of weight and height was not available to compute Body Mass Index (BMI) scores. BMI scores were calculated using the following formula, (weight (lb) / [height (in)] 2 x 703). An additional 114 individuals (70%, n Female = 80) younger than18 years old or 25 years old or older were excluded from the present study to establish a representative college sample. Finally, four participants were removed from the analysis due to the outlier analysis on BMI. The final sample consisted of 830 participants (nfemale = 618; nmale = 212) ages 18 to 24 years old (M = 19.48, SD = 1.50) with an average BMI of (SD = 4.87). The mean age of women was years old (SD = 1.44). Their BMI scores ranged from to (M = 23.55, SD = 5.02). Using the standard weight status categories; underweight (BMI < 18.5), normal (BMI between 18.5 and 24.9), overweight (BMI between 25 and 29.9) and obese (BMI > 30.0), 8% (n = 51) qualified as being underweight, 64% (n = 397) normal, 18% (n = 110) overweight, and 10% (n = 60) obese. The female group was diverse in ethnic background with 37% (n = 230) identifying as European American, 32% (n = 197) identifying as African American, 15% (n = 93) identifying as Asian American/Pacific Islander, 6% (n = 34) identifying as Hispanic American, 10% (n = 64) identifying as bicultural or other, and one identifying as Native American. The mean age of men was years old (SD = 1.66). The BMI scores ranged from to (M = 23.68, SD = 4.42). Six percent (n = 12) of men fell within the underweight range, 64% (n = 136) normal, 25% (n = 52) overweight, and 6% (n = 12)

9 Running head: SELF-CONCEALMENT AND DISORDERED EATING 8 obese. The male group was also diverse in ethnic background with 39% (n = 82) identifying as European American, 27% (n = 57) identifying as African American, 21% (n = 45) identifying as Asian American/Pacific Islander, 5% (n = 11) identifying as Hispanic American, 8% (n = 16) identifying as bicultural or other, and one identifying as Native American. Measures and Procedure The current study was approved by the Institutional Review Board of the university. Participants completed an anonymous web-based survey. Prior to the survey, the purpose of the study and instructions for responding were presented to the participants. The following measures were administered to assess self-concealment, psychological flexibility, and DE symptoms. Self-concealment. The Self Concealment Scale (SCS; Larson & Chastain, 1990) is a self-report inventory designed to measure a person's tendency to conceal personal information that is distressing (e.g., There are lots of things about me that I keep to myself ). The SCS contains 10 items and employs a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) for each item. The total score is derived from the sum of responses to all items, with greater values indicating greater self-concealment. The SCS is a reliable measure of self-concealment, with test-retest (over 4 weeks) and interitem reliability estimates of.81 and.83, respectively (Larson & Chastain, 1990). In the present study, Cronbach s alpha of this measure was.88. Psychological flexibility. The Acceptance and Action Questionnaire-16 item (AAQ-16; Bond & Bunce, 2003) was used to measure psychological flexibility. The AAQ- 16 is a 16-item questionnaire designed to assess willingness to accept undesirable thoughts

10 Running head: SELF-CONCEALMENT AND DISORDERED EATING 9 and feelings (e.g., It is OK to feel depressed or anxious ) and acting in a way that is consistent with one s values and goals (e.g., I am able to take action on a problem even if I am uncertain of the right thing to do ). The measure uses a 7-point Likert scale, ranging from 1 (never true) to 7 (always true). Total scores range from 16 to 112, with higher scores indicating greater psychological flexibility. Research has indicated that the AAQ has adequate psychometric properties (Bond & Bunce, 2003). In a previous study conducted with a non-clinical sample (Bond & Bunce, 2003), Cronbach s alpha for this measure ranged from.72 to.79. The Cronbach s alpha of this measure was.62 in the present study. Disordered eating. The 26-item version of the Eating Attitudes Test (EAT-26; Garner et al., 1982) is a self-report inventory for assessing general eating disorder pathology (e.g., I am terrified about being overweight, and I vomit after I have eaten ). Each of the 26 items is scored on a 6-point Likert scale: never (0), rarely (0), sometimes (0), often (1), very often (2), or always (3). The measure also forms three subscales: (a) Dieting, (b) Bulimia and Food Preoccupation, and (c) Oral Control. The Dieting subscale consists of 13 items to detect negative body image and avoidance of fattening foods (e.g., particularly avoid food with high carbohydrate content ). The Bulimia and Food Preoccupation subscale consists of 6 items, designed to measure obsessive thoughts toward food as well as bulimic behaviors (e.g., have gone on eating binges where I feel that I may not be able to stop ). The Oral Control subscale, which consists of 7 items, measures food restriction and pressure felt from others to gain weight (e.g., avoid eating when I am hungry ). Higher scores in each subscale reflect greater eating disorder pathology in the specific symptomatic domain. In the current study, Cronbach s alphas of Dieting, Bulimia and Food Preoccupation, and Oral Control subscales were.85, 79, and.64, respectively.

11 Running head: SELF-CONCEALMENT AND DISORDERED EATING 10 Data Analysis In the present set of analyses, gender was dummy coded as 1 = male and 2 = female, and ethnicity as 1 = ethnic minority and 2 = Caucasian American. We first examined zero-order correlations among all study variables. Then hierarchical multiple regressions were used to examine how self-concealment and psychological flexibility were uniquely associated with DE outcomes and whether these associations varied by gender. Three regressions were performed in a three-step procedure. The first step included gender, ethnicity, and BMI as covariates. The second step included self-concealment and psychological flexibility. The two-way interactions of self-concealment and psychological flexibility by gender were separately entered in step three. Preliminary analyses revealed that all DE outcomes (i.e., dieting, bulimia/food preoccupation, and oral control) were positively skewed. Additionally, 28% of men (n = 60) and 19% of women (n = 117) did not endorse any symptoms in dieting, 72% of men (n = 153) and 67% of women (n = 414) in bulimia/food preoccupation, and 31% of men (n = 67) and 33% of women (n = 208) in oral control. As such, all DE outcomes were log10 transformed after adding a constant (i.e., 1); transformed data were used in all subsequent analyses. Self-concealment and psychological flexibility scores were standardized (i.e., z- scored) and standardized scores were used to compute interaction terms and used for all regression analyses. Results Associations among Study Variables Descriptive statistics and correlations among study variables are presented in Table 1. Self-concealment was significantly and positively associated with dieting (i.e., avoidance

12 Running head: SELF-CONCEALMENT AND DISORDERED EATING 11 of fattening foods and a preoccupation with being thinner) and bulimia/food preoccupation (i.e., thoughts about food as well as those indicative of bulimia). Conversely, psychological flexibility was significantly and inversely related to diet and bulimia/food preoccupation. Neither self-concealment nor psychological flexibility was associated with oral control (i.e., food intake restriction and the perceived pressure from others to gain weight). There was a significant inverse association between self-concealment and psychological flexibility. BMI was positively associated with dieting and bulimia/food preoccupation and inversely related to oral control. Finally, being female was significantly associated with greater dieting and lower psychological flexibility. Role of Self-Concealment and Psychological Flexibility on DE Symptoms The final steps of three hierarchical regression analyses are presented in Table 2. The results of the first hierarchical regression suggested that, after controlling for the effects of gender, ethnicity, and BMI (Step 1; R 2 =.05, p <.01), self-concealment (β =.13, p <.01) and psychological flexibility (β = -.19, p <.01) were related to dieting (Step 2; R 2 =.07, p <.01). Furthermore, the association between self-concealment and dieting was found to vary by gender (β =.36, p <.05; Step 3 R 2 =.01, p <.05). To examine the specific form of this significant self-concealment by gender interaction, the slope of the final equation was computed at points that corresponded to high and low levels of the predictor variables (+ 1.0 SD) (Aiken & West, 1991). The positive association between self-concealment and dieting was significantly more likely in the female group than in the male group (Figure 1). The results of the second hierarchical regression suggested that, after controlling for the effects of gender, ethnicity, and BMI (Step 1; R 2 =.01, p >.05), psychological

13 Running head: SELF-CONCEALMENT AND DISORDERED EATING 12 flexibility (β = -.20, p <.01), but not self-concealment (β =.04, p >.05), was related to bulimia/food preoccupation (Step 2; R 2 =.05, p <.01). Gender did not moderate the association between self-concealment and bulimia/food preoccupation or the link between psychological flexibility and bulimia/food preoccupation (Step 3; R 2 =.00, p >.05). The third regression revealed that after controlling for the key demographic variables (Step 1; R 2 =.02, p <.01), neither self-concealment nor psychological flexibility were significantly associated with oral control (Step 2; R 2 =.00, p >.05). Furthermore, gender did not moderate the association between self-concealment and bulimia/food preoccupation or the link between psychological flexibility and bulimia/food preoccupation (Step 3 R 2 =.00, p >.05). Finally, after controlling for other demographic and process variables as well as interaction terms, greater BMI was found to be associated with greater dieting, greater bulimia/food preoccupation, and lower oral control. Discussion The present study investigated whether self-concealment and psychological flexibility were uniquely associated with different facets of DE and whether these associations varied across gender. As expected, both self-concealment and psychological flexibility were uniquely associated with dieting after controlling for gender, ethnicity, and BMI. However, contrary to our prediction, psychological flexibility, but not selfconcealment, was uniquely associated with bulimia/food preoccupation. Furthermore, neither self-concealment nor psychological flexibility were uniquely related to oral control after controlling for these key demographic variables. Finally, gender was found to moderate the association between self-concealment and dieting; the association between the two variables was found for women, but not men. In sum, the present study has shown

14 Running head: SELF-CONCEALMENT AND DISORDERED EATING 13 that self-concealment and psychological flexibility are relevant to some facets of DE, but not to others, and that self-concealment is a useful construct in understanding dieting in women, but not in men. Conceptually, our findings also suggest that different facets of DE may function differently from one another and that topographically identical DE symptoms (e.g., diet) may be qualitatively and functionally distinct across gender. For example, while dieting and bulimia/food preoccupation seem to reflect rigid and avoidant patterns, oral control does not. Similarly, while dieting seems to involve secretiveness in women, dieting does not seem to be relevant to the behavioral tendency of secrecy in men. Although it is beyond the scope of the present study, the gender difference can be attributable to differential psychosocial contingencies operating across gender; while dieting is socially acceptable practice in men, behavior of dieting may be linked to negative psychosocial connotations in women, such as the signs of negative body image and feelings of insecurity. Given previous findings (Masuda, Boone, et al., 2011), the lack of significant associations between the present process variables (i.e., self-concealment and psychological flexibility) and oral control was somewhat surprising. As mentioned above, this set of findings can be attributable to the qualitatively unique nature of oral control. In particular, contrary to other facets of DE symptoms (diet, bulimia/food preoccupation), which are likely to be negatively reinforced (Lillis, Hayes, & Levin, 2011; Rawal et al., 2010), oral control may function differently across individuals (Mizes et al., 2000; Slade, 1982). While oral control may be negatively reinforced in some individuals, it may be positively reinforced in others. The present findings may parallel with extant literature suggesting food intake restriction, a behavior pattern captured by the construct of oral

15 Running head: SELF-CONCEALMENT AND DISORDERED EATING 14 control, to be qualitatively distinct from other DE symptoms (dieting, binging, and purging) (Wonderlich, Joiner, Keel, Williamson, & Crosby, 2007). The present study also has implications for practice. Our findings suggest investigating self-concealment and psychological flexibility and their associations with different facets of DE may be useful to elucidate the functional nuances of these DE symptoms. This practical implication parallels the recent acceptance- and mindfulnessbased cognitive behavioral therapies (Hayes, Follette, & Linehan, 2004), which target affect/behavioral regulation for the amelioration of human struggles. Preliminary evidence indicates that these treatment modalities are effective in decreasing DE and in improving psychological health (Berman, Boutelle, & Crow, 2009; Juarascio, Forman, & Herbert, 2010; Martín-Murcia, Díaz, & Gonzalez, 2011; Masuda, Muto, Hayes, & Lillis, 2008; Pearson, Follette, & Hayes, 2011). Our study supports these treatments by elucidating a potential relevance of psychological flexibility and self-concealment to specific facets of DE symptoms across gender. The present study had several notable limitations. First, the associations among selfconcealment, psychological flexibility, and DE symptoms, while statistically significant, were small. As such, interpreting the present findings as well as deriving conceptual and theoretical implications requires extra cautions. Our findings suggest that other factors are likely to contribute to the onset and maintenance of DE symptoms. To investigate this possibility, future studies should investigate the roles of self-concealment, psychological flexibility, and gender while controlling for other well-known correlates, such as neuroticism (Tylka & Subich, 2004), perfectionism (Brannan & Petrie, 2008), and body image dissatisfaction and disturbance (Stice, Hayward, Cameron, Killen, & Taylor, 2000).

16 Running head: SELF-CONCEALMENT AND DISORDERED EATING 15 Alternatively, the lack of associations or small associations between the process variables of interest and DE symptoms might have been due to the limited variance across DE symptoms measured by the subscales of EAT-26 to examine the present research hypotheses. As such, further study is warranted, particularly in a sample of males and females with eating disorder diagnoses. Second, the external validity of our findings is limited as they were derived exclusively from undergraduate students attending an urban area university in the southeastern United States. As such, sociocultural factors specific to the present sample, such as religious and political climates, ethnic group compositions, and university culture, are likely to influence the variables of interest. Psychometrically, the scales used in the present study have not been fully tested and validated in individuals from diverse ethnic backgrounds. Additionally, the coefficient alphas of the AAQ-16, a measure of psychological flexibility, and the Oral Control subscale of EAT-26 were lower than a conventionally acceptable level. Future studies should employ more psychometrically sound measures of psychological inflexibility, such as the Acceptance and Action Questionnaire-II (AAQ-II) (Bond et al., 2011) and DE, such as the Eating Disorder Examination Questionnaire (EDE-Q) (Fairburn, 2008). Finally, the most notable limitation was that the present study was a cross-sectional investigation with the exclusive reliance on self-report measures. The study did not permit any causal inferences or functional associations among the variables of interest. Given the present methodology (i.e., web-based survey study), it is unclear whether the scores, including the BMI, were subject to errors, although the anonymous nature of a web-based study might have decreased biases. From a functional and contextual perspective, the

17 Running head: SELF-CONCEALMENT AND DISORDERED EATING 16 variables of our interest (e.g., psychological flexibility and dieting) are ongoing behavioral processes in a given context. As such, the use of behavioral observation methods, if possible, seems suitable for investigating the present research questions. Limitations notwithstanding, the present study adds additional evidence regarding associations among self-concealment, psychological flexibility, gender, and specific facets of DE. Our findings suggest that the associations among self-concealment, psychological flexibility, and DE vary depending on gender and specific facets of DE.

18 PSYCHOLOGICAL FLEXIBILITY AND DISORDRED EATING BEHAVIOR 17 Table 1 Means, Standard Deviations and Zero-Order Relations between all Variables Diet Bulimia and Food Preoccupation.52** Oral Control.20**.29** Self-Concealment.20**.13** Psychological Flexibility -.26** -.22** ** Gender.12** ** Ethnicity *.09* BMI.20**.08* -.10** * M 5.22 ª 1.19ª 2.27ª 28.95ª 70.62ª 23.58ª SD 6.24 ª 2.51ª 2.87ª 8.55ª 9.06ª 4.87ª Note: *p <.05, **p <.01, N = 830. ªthe value was calculated based on raw data.

19 PSYCHOLOGICAL FLEXIBILITY AND DISORDRED EATING BEHAVIOR 18 Table 2 Final Step of a Hierarchical Linear Regression Examining the Role of Self-Concealment, Psychological Flexibility, and Gender on Psychological Distress. b SE β Diet Intercept Gender Ethnicity BMI.02 * Self-Concealment Psychological Flexibility Self-Concealment x Gender.09 * Psychological Flexibility x Gender Bulimia and Food Preoccupation Intercept Gender Ethnicity BMI.01 * Self-Concealment Psychological Flexibility Self-Concealment x Gender Psychological Flexibility x Gender Oral Control Intercept Gender Ethnicity BMI -.01 ** Self-Concealment Psychological Flexibility Self-Concealment x Gender Psychological Flexibility x Gender Note. *p <.05, **p <.01, N = 830

20 PSYCHOLOGICAL FLEXIBILITY AND DISORDRED EATING BEHAVIOR Diet Males Females Low Self-Concealment High Self-Concealment Figure 1. Gender moderates the association between self-concealment and dieting. High and low values of self-concealment correspond to + 1 SD from the mean. Dieting scores were long-transformed, M =.60, SD =.42.

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